DC SIM Advisory

Committee Meeting

March 9, 2016

Agenda

• Introductions

• Progress

• SHIP Overview

• Environmental Scan

• Long-Term Strategy Discussion

• Next Steps & Questions 2

Progress Since Last

Advisory Committee Meeting

• Work Group Meetings with 453 Stakeholders

– Care Delivery: February 3rd, March 2nd

– Joint Community Linkages/Care Delivery: January 12th

– Joint Quality Metrics/Care Delivery: January 20th

– Payment Models: February 5th

– Community Linkage: February 17th

– Quality Metrics: February 22nd

• Innovation Updates – SIM Weekly Newsletters

• Consumer Engagement – Soliciting feedback on healthcare in the District from consumer perspective, especially targeting super-utilizers

- Consumer Interviews: Mary’s Center, Unity, Providence, George Washington

- Focus Groups: Scheduled March 29th and March 30th

• Provider Engagement – Feedback on healthcare in the District from the provider perspective

- Developed online survey that will be sent to Medicaid providers

3

Pivoting from Short to Long-Term Goals

Health Home 2

- Value – based

payment

- Integrate Medical

& Social Services

- Data Exchange

- Capacity Building

4

Driver Diagram Frames SIM Workgroup

Discussions

5

SHIP as Part of the State Innovation Model (SIM)

• Main deliverable to CMS as part of the District’s

SIM is the State Health Innovation Plan (SHIP)

• Iterative process that requires significant

feedback from the Advisory Committee and

Workgroups

Today’s meeting: Present high-level Environmental

Scan findings and solicit feedback from Committee

on Key Discussion Topics

6

DC Environmental Scan

Findings

First Component of

the SHIP

7

DC Environmental Scan: Population Health, By Ward

Measure

Ward

1

Ward

2

Ward

3

Ward

4

Ward

5

Ward

6

Ward

7

Ward

8 US

Health Status

as Fair or Poor 12.6% 8.9% 4.2% 17.4% 17.0% 7.9% 17.6% 29.5% 16.7%

Adults with

High Blood

Pressure

28.6% 23.8% 24.0% 32.3% 37.2% 29.6% 42.9% 37.7% 31.4%

Obesity 24.9% 15.3% 12.0% 27.2% 32.1% 22.1% 35.0% 42.8% 29.4%

Current

Smoker 15.5% 8.6% 9.3% 14.4% 20.4% 17.3% 24.1% 41.0% 18.8%

Diabetes 6.6% 4.8% 3.1% 8.4% 10.9% 6.5% 14.5% 16.0% 9.7%

*All data is self-reported through the Behavioral Risk Factor Surveillance

System (BRFSS)

District of Columbia, Department of Health. (2015, June). Annual Health Report: behavioral Risk Factor Surveillance System. Retrieved from http://doh.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/2013%20Final%20BRFSS%20Annual%20Report%207%2029%2015.pdf.

8

DC Environmental Scan: Health Care Utilization

Healthcare Utilization Metric DC

United

States

Medicare 30-day hospital readmissions per

1,000 beneficiaries, 2012 65 45

Emergency Department Visits per 1,000

population, 2013 746 423

Mortality amenable to healthcare, deaths

per 100,000 population, 2012-2013 119 82

The Commonwealth Fund. (2015). Health System Data Center: District of Columbia. Retrieved from http://datacenter.commonwealthfund.org/scorecard/state/10/district-of-columbia/. The Kaiser Family Foundation. (2013). Hospital Emergency Room Visits per 1,000 population by ownership type. Retrieved from http://kff.org/other/state-indicator/emergency-room-visits-by-ownership/ The Commonwealth Fund. (2015). Health System Data Center: District of Columbia. Retrieved from http://datacenter.commonwealthfund.org/scorecard/state/10/district-of-columbia/.

9

Key Data Takeaways (FY14)

10

• Average Per Person Spending: $10,050

• FFS: $27,378 (based on 58,034 beneficiaries with a claim in FY14)

• MCO: $4,014 (based on 166,586 beneficiaries with a claim in FY14)

• ED Visits: 70,649 MCO beneficiaries had an ED visit (42% of MCO as compared to 23% of FFS)

• IP Visits: 12,987 FFS beneficiaries had an IP visit (22% of FFS as compared to 9% of MCO)

• Long-Term Care: Comprises 32% ($757,026,295) of total Medicaid expenditures

Total Medicaid

Population

• Proportion of Spending (FFS and MCO):

• Top 1 percentile: 2,339 beneficiaries make up 27% of total Medicaid spending

• Top 5 percentile: 13,855 beneficiaries make up 60% of total Medicaid spending

• Average Per Person Spending within Top 1 Percentile:

• FFS: $495,861

• MCO: $206,125

• Top 10 Chronic Conditions within Top 1 Percentile: 1) Hypertension; 2) Behavior Problems; 3) Diabetes; 4) Dementia; 5) Paralysis; 6) Cerebrovascular Disease; 7) Chronic Renal Failure; 8) CHF; 9) Hyperlipidima; and 10) Depression

High Cost Beneficiaries

DC Environmental Scan: Medicaid Spending

• High utilization of healthcare services by a small number of

Medicaid beneficiaries has led to a majority (60%) of

Medicaid spending by the top five percent of Medicaid

beneficiaries

• High-Cost DC Medicaid Beneficiaries Proportion of

Spending, 2014

95%

40%

4%

33%

1%

27%

MEDICAID POPULATION MEDICAID SPENDING

DC Department of Health Care Finance. (2015). Medicaid Management Information System. 11

DC Environmental Scan:

Health Care Utilization

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Percent who hadgeneral doctor or

provider visit in pastyear, 2012

Percent who had visitto emergency

department in pastyear, 2012

Percent who spent thenight in hospital in

past year, 2012

District of Columbia United States

State Health Access Data Assistance Center. (2015). State Profile: District of Columbia. Retrieved http://www.shadac.org/state/dc 12

Overview of Environmental Scan

• Establishes baseline and informs goals for SIM transformation efforts

• Includes multiple published and unpublished data sources – American Community Survey (ACS) 2014 – Behavioral Risk Factor Surveillance System (BRFSS) 2015 – Centers for Disease Control and Prevention, Health Disparities Report – The Commonwealth Fund, Health System Data Center – U.S. Census Bureau, District of Columbia Quick Facts – District of Columbia Department of Health Board of Medicine – District of Columbia Department of Health Annual Health Report – District of Columbia Interagency Council on Homelessness – Kaiser Family Foundation, State Health Statistics – RAND Corporation, Assessing Health and Health Care in District of Columbia – State Health Access Data Assistance Center, District of Columbia State Profile – The District’s Medicaid Management Information System 2015

Question for the Advisory Committee:

Is the scan missing any vital data or information sources to frame the issue? 13

Consumer and Provider Engagement

Incorporated into Environmental Scan

• General Information

• Access to Primary Care and Provider Satisfaction

• Gaps in Health Care

• Emergency Department Utilization

• Ability to Manage Chronic Conditions (Focus Group Only)

• Access to Social Services

• Overall Satisfaction with DC Healthcare System

Consumer Interviews & Focus Group

• General Information

• Patient Demographics

• Barriers to Accessing Care for your Patients

• Information Sharing

• Healthcare Transformation

• Hospital-Based Providers only

Provider Survey

14

Five-Year Innovation

Roadmap

15

Identify Overlapping Priorities

Public Insurance (Medicaid)

Reduce inappropriate utilization

Public Health

Address high morbidity

and mortality conditions;

Health Equity

Priorities

End long-term homelessness;

Healthy living in all 8 Wards; Combat HIV/AIDS

Person-Centric

Improve access to care

and experience of

care

SIM Priorities:

Leverage Payment and Delivery Reforms to:

• Address high-mortality & morbidity conditions (e.g. cancer, diabetes, cerebrovascular, heart disease & respiratory)

• Address high-cost conditions (e.g. hypertension, heart disease, diabetes, HIV/AIDS, behavioral health)

• End chronic homelessness

• Reduce disparities 16

What Is the District’s Long-Term Vision?

Reducing Disparities

• What are the specific dimensions of disparities that the District should consider as its top priority/ies?

Monitoring & Evaluation

• How will the District know that it has made meaningful and measureable progress on reducing disparities?

Capacity Building

• What should the District’s workforce look like in the future? What investments need to be made in order to transform today’s workforce?

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Next Steps

• Gather information through consumer interviews and focus groups, and provider surveys; present finding in mid-April

• Continue to develop SHIP based on Work Group and Advisory Committee recommendations

• Interim SHIP Presentation at May Advisory Committee Meeting (see next slide)

18

SHIP Development Timeline

Midterm SHIP Report

• 2/12/16 – Outline complete

• 3/09/16 – Solicit and Incorporate Advisory Committee Comments on Key SHIP Discussion Areas

Interim SHIP Report

• 5/09/16 – Finalize Interim SHIP

• 5/11/16 – Present to Advisory Committee

• 5/16/16 – Share Interim SHIP w/ Work Groups

• 6/01/16 – Incorporate Feedback

Final SHIP Report

• 6/17/16 – Submit to DHCF for Final Edits

• 7/13/16 – Submit Final SHIP to Advisory Committee for Approval

• 7/31/16 – Submit to CMS

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